By: Judith King (Copy and Content Editor: SA SURE )
Sakhisizwe Community Development Organisation is a community-based organisation based (CBO) in KwaMnyathi (Vryheid) – formerly a mining area in Zululand District. Due to closure of the mines, 85% of residents are now unemployed, and with limited skills, people were left to fend for themselves.
There has been a noticeable rise in HIV infections in KwaMnyathi, where traditional culture has undermined disclosure due to the stigma associated with HIV which, in turn, makes continuity of treatment challenging. Sakhisizwe was contracted by the Health Systems Trust (HST) to set up adherence clubs for four facilities in the Abaqulusi Sub-district.
Sakhisizwe's first step was to adopt a strategy for recruiting patients newly initiated on antiretroviral therapy (ART) into treatment support groups. This intervention was implemented to create a good relationship between Sakhisizwe Facilitators, patients and community members. In this way, the CBO formed a pool of people who could be supported in their treatment journey towards qualifying for membership of adherence clubs.
The National Department of Health's Central Chronic Medicine Dispensing and Distribution (CCMDD) programme – also known as DablapMeds – enables patients who are stable on their medication to avoid costly and inconvenient clinic visits every month by collecting treatment at their chosen pick-up point outside the facility. HST runs an awareness-creation campaign focused on CCMDD in eThekwini called Get checked. Go collect in support of the NDoH and Dablapmeds.
Adherence clubs offer this collection option, along with a welcoming space in which patients can meet to receive advice on and discuss their adherence challenges and other issues related to health and wellbeing with their peers. This system also relieves the burden on health facilities, shortens the queues for those who have to attend the clinic, and supports prevention of COVID-19 infection.
The CBO also markets the adherence clubs to stakeholders in Operation Sukuma Sakhe ('stand up and build') War Room gatherings and Traditional Council meetings. The aim of these presentations is to foster a clear understanding of the clubs' purpose and the important role that they play in helping people living with HIV to remain virally suppressed.
The Sakhisizwe CBO team
Working hand-in-hand with the facility staff (Operational Managers, CCMDD Champions and HST team members), Sakhisizwe has formed 23 adherence clubs as at March 2021.
One of Sakhisizwe's four allocated facilities is Vumani Clinic, situated approximately 38 kilometres from Vryheid. Despite it being a small facility, nine adherence clubs have been established. Recruiting was supported by Vumani Clinic staff, War Room delegates, the CCMDD Champion, and Traditional Council leaders. HST provided training and support for facilitation of these clubs.
Participation in the clubs has generated a positive change in the members' lifestyle, as the patients are now applying the guidance they receive to make healthy choices and find ways of adhering to treatment. Those whose treatment is interrupted are easy to trace and return to care. Also, more people are willing to be a part of adherence clubs, as word has spread that medication can be collected closer to their homes and health education assists patients in disclosing their HIV status.
Nozipho Khuzwayo, one of the Club Facilitators from Mason Street Clinic, shares that although the venue for Lakeside (an urban and semi-urban area) is Lakeside Hall and patients are positive about their adherence club membership, they prefer to collect their medication from the facility. "This has taught me to accommodate their wishes and to respect their choice of pick-up point," she says. "When they arrive at the clinic, they are directed to me for this service and I am happy to observe the grace period for collection."
Nozipho also applauds the Community Health Workers for their assistance in tracing patients who do not arrive to collect their medication. "Their knowledge of the households is invaluable for supporting patients' continuity of treatment."
Project Manager of the Sakhisizwe Community Development Programme, Mrs Phumzile Doris Zulu.
The lesson learnt in this process is that success is ensured through the
integrated approach of working with key stakeholders – fieldworkers, community
structures, government officials, businesses and civil society – who share a
commitment to helping people live healthy lives.